This invention relates to devices employed in cardiac bypass surgery, particularly to such devices employed for minimally invasive procedures.
Typical coronary bypass surgery is a major and traumatic procedure from which recovery is difficult and protracted. A very large incision is required and the patient's chest must be "cracked" at the breastbone so that it may be opened wide for the surgeon to gain access to the heart with hands and operating instruments.
Therefore, a minimally invasive procedure for bypass surgery is highly preferable. In such a procedure, a relatively small incision is made over the fourth coastal cartilage or, alternatively, in the upper abdominal midline, the incision being just large enough for a localized operation on the heart or arterial system. Importantly, the patient's ribs do not have to be cut and reattached, though a small portion of cartilage is typically removed. Moreover, the incision, being small, is more easily and quickly healed. It has been found that, often, patients may leave the hospital after such a procedure within one or two days.
However, access to the heart is made more difficult in the minimally invasive procedure. The access aperture is smaller, requiring that the surgical instruments employed must be capable of functioning in very tight quarters. Moreover, minimizing the size of the access aperture to minimize trauma has necessarily required sacrificing the facility with which it is possible to reach and operate on distant locations on the heart and the local arterial system from the aperture.
In the typical coronary bypass procedure, the surgeon often desires to elevate and tilt the heart for improved access for dissecting the graft site as well as for suturing. This has been done by placing laparotomy pads, or rolled towels, underneath the heart. In the minimally invasive procedure, the need is even greater to manipulate the heart to improve access. However, because of the small incision, which is typically about 4 centimeters long, there is not room for placing towels or laparotomy pads underneath the heart.
Accordingly, there is a need for a cardiac manipulator for use in minimally invasive surgical procedures that provides for increasing the surgeon's access to the heart and the local arterial system through a minimally sized access aperture.